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01-09-2020 | Multiple Sclerosis | Original Article

Plasma exchange in acute attacks of demyelinating diseases of the central nervous system: clinical outcomes and predictors of response

Authors: Michael A. Palacios-Mendoza, María L. Martínez Ginés, Pedro J. Melgarejo Otálora, Juan P. Cuello, Antonio Sánchez-Soblechero, Alberto Lozano Ros, José A. Aparcero-Suero, Sergio López Anguita, Fernando Anaya, José M. García Domínguez

Published in: Neurological Sciences | Issue 9/2020

Abstract

Background

Plasma exchange (PLEX) is a therapeutic option in the treatment of acute attacks of Demyelinating Diseases of the Central Nervous System (DDCNS). Factors related with PLEX response are not well established.

Methods

Descriptive and retrospective study. We included patients treated with PLEX for acute attacks of DDCNS between 2008 and 2017. We recorded demographics, clinical and treatment-related data, and Expanded Disability Status Scale (EDSS) score at admission, at discharge, and at 6 months.

Results

We included 64 patients. Forty-eight (75%) were female with a mean age of 48.28 ± 11.5 years. Half of our patients were diagnosed with multiple sclerosis. Clinical improvement was achieved in 51.6% at discharge and 62.5% at 6 months. The logistic regression model showed that EDSS score > 3 at admission (p = 0.04) and early clinical improvement with PLEX (p = 0.00) were predictors of good response to PLEX at discharge and at 6 months, respectively. No serious adverse effects were identified.

Conclusions

PLEX is a safe and effective treatment for acute attacks of DDCNS. EDSS score at admission and early clinical improvement with PLEX were factors associated with good response to PLEX.

Llufriu S, Castillo J, Blanco Y, Ramio-Torrenta L, Rio J, Valles M, Lozano M, Castella MD, Calabia J, Horga A, Graus F, Montalban X, Saiz A (2009) Plasma exchange for acute attacks of CNS demyelination: predictors of improvement at 6 months. Neurology 73(12):949–953. https://doi.org/10.1212/WNL.0b013e3181b879beCrossRefPubMed

Magaña S, Keegan B, Weinshenker B, Erickson B, Pittock S, Lennon V, Rodriguez M, Thomsen K, Weigand S, Mandrekar J, Linbo L, Lucchinetti CF (2012) Beneficial plasma exchange response in CNS inflammatory demyelination. Arch Neur 68(7):870–878. https://doi.org/10.1001/archneurol.2011.34CrossRef

Tombak A, Uçar MA, Akdeniz A, Yilmaz A, Kaleagası H, Sungur MA, Tiftik EN (2017) Therapeutic plasma exchange in patients with neurologic disorders: review of 63 cases. Indian J Hematol Blood Transfus 33(1):97–105. https://doi.org/10.1007/s12288-016-0661-3CrossRefPubMed

Láinez-Andrés JM, Gascón-Giménez F, Coret-Ferrer F, Casanova-Estruch B, Santonja JM (2015) Recambio plasmático terapéutico: aplicaciones en neurología. Rev NeurolRev Neurol 60(3):120–131. https://doi.org/10.33588/rn.6003.2014393CrossRef

Kaya E, Keklik M, Şencan M, Yilmaz M, Keskin A, Kiki I et al (2013) Therapeutic plasma exchange in patients with neurological diseases: multicenter retrospective analysis. Transfus Apher SciTransfus Apher Sci 48(3):349–352. https://doi.org/10.1016/j.transci.2013.04.015CrossRef

Correia I, Ribeiro JJ, Isidoro L, Batista S, Nunes C, Macário C et al (2018) Plasma exchange in severe acute relapses of multiple sclerosis – results from a Portuguese cohort. Mult Scler Relat Disord 19:148–152. https://doi.org/10.1016/j.msard.2017.12.001CrossRefPubMed

Schröder A, Linker RA, Gold R (2010) Plasmapheresis for neuroinflammatory disorders. Clin Exp Neuroimmunol 1(3):95–102. https://doi.org/10.1111/j.1759-1961.2010.00010.xCrossRef

Keegan M, König F, McClelland R, Brück W, Morales Y, Bitsch A et al (2005) Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange. Lancet 366(13):579–582. https://doi.org/10.1016/S0140-6736(05)67102-4CrossRefPubMed

Weinshenker BG, O’Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW et al (1999) A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol 46(6):878–886. https://doi.org/10.1002/1531-8249(199912)46:6<878::AID-ANA10>3.0.CO;2-QCrossRefPubMed

10.

Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG (2002) Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 58(1):143–146. https://doi.org/10.1212/WNL.58.1.143CrossRefPubMed

11.

Ehler J, Koball S, Sauer M, Mitzner S, Hickstein H, Benecke R et al (2015) Response to therapeutic plasma exchange as a rescue treatment in clinically isolated syndromes and acute worsening of multiple sclerosis: a retrospective analysis of 90 patients. PLoS One 10(8):1–12. https://doi.org/10.1371/journal.pone.0134583CrossRef

12.

Watanabe S, Nakashima I, Misu T, Miyazawa I, Shiga Y, Fujihara K, Itoyama Y (2007) Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica. Mult SclerMult Scler 13:128–132. https://doi.org/10.1177/1352458506071174CrossRef

13.

Aungsumart S, Apiwattanakul M (2017) Clinical outcomes and predictive factors related to good outcomes in plasma exchange in severe attack of NMOSD and long extensive transverse myelitis: Case series and review of the literature. Mult Scler Relat Disord 13:93–97. https://doi.org/10.1016/j.msard.2017.02.015CrossRefPubMed

14.

Morgan S, Zantek N, Carpenter A (2014) Therapeutic plasma exchange in neuromyelitis optica: a case series. J Clin Apher 29:171–177. https://doi.org/10.1002/jca.21304CrossRefPubMed

15.

Lim YM, Pyun SY, Kang BH, Kim J, Kim KK (2013) Factors associated with the effectiveness of plasma exchange for the treatment of NMO-IgG-positive neuromyelitis optica spectrum disorders. Mult Scler JMult Scler J 19(9):1216–1218. https://doi.org/10.1177/1352458512471875CrossRef

16.

Greenberg B, Thomas K, Krishnan C, Kaplin A, Calabresi P, Kerr D (2007) Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide. Neurology 70(2):160. https://doi.org/10.1212/01.wnl.0000260970.63493.c8CrossRef

17.

Trebst C, Reising A, Kielstein JT, Hafer C, Stangel M (2009) Plasma exchange therapy in steroid-unresponsive relapses in patients with multiple sclerosis. Blood Purif 28(2):108–115. https://doi.org/10.1159/000224630CrossRefPubMed

Title: Plasma exchange in acute attacks of demyelinating diseases of the central nervous system: clinical outcomes and predictors of response
Authors: Michael A. Palacios-Mendoza
María L. Martínez Ginés
Pedro J. Melgarejo Otálora
Juan P. Cuello
Antonio Sánchez-Soblechero
Alberto Lozano Ros
José A. Aparcero-Suero
Sergio López Anguita
Fernando Anaya
José M. García Domínguez
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keywords: Multiple Sclerosis
Optic Neuritis
Neuromyelitis Optica Spectrum Disease
Demyelinating Disease
Published in: Neurological Sciences / Issue 9/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04382-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Plasma exchange in acute attacks of demyelinating diseases of the central nervous system: clinical outcomes and predictors of response

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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